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General NPI Number Information
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NPI Number | 1588846257
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Entity Type | Organization
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Legal Business Name | NITIN BAWA, PA
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 4476 LEGENDARY DR STE 100
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City | DESTIN
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State | FL
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Zip | 32541-5347
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Country | US
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Telephone | 850-424-7320
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Fax | 850-424-7322
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Provider Business Mailing Address
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Address Line | 4476 LEGENDARY DR STE 100
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City | DESTIN
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State | FL
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Zip | 32541-5347
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Country | US
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Telephone | 850-424-7320
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Fax | 850-424-7322
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. NITIN BAWA
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Credential | M.D.
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Telephone | 850-534-4170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME91017
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License Number State | FL
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